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[Early short-term treatment of neonatal hip instability with the Pavlik harness]
Y Lefèvre1, J-M Laville, F Salmeron
1Service de Chirurgie Infantile, CHD Félix-Guyon, 97405 Saint-Denis, La Réunion. chir-infantile@chd-fguyon.fr
Insights
Early Pavlik harness treatment effectively reduces and stabilizes dislocated hips in newborns, correcting acetabular dysplasia in 97.7% of cases. This method avoids complications, offering a safe and successful approach for infantile hip dislocation.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Developmental Dysplasia of the Hip (DDH) is a condition where the hip socket does not fully cover the ball portion of the upper thighbone.
- Early diagnosis and intervention are crucial for successful treatment and preventing long-term complications.
- The Pavlik harness is a common orthopedic device used for treating DDH in infants.
Purpose of the Study:
- To evaluate the efficacy of early, short-term Pavlik harness treatment for reducible or highly unstable dislocated hips in newborns.
- To assess the spontaneous correction of acetabular dysplasia when the hip is reduced and stabilized.
Main Methods:
- A study included 34 patients with 44 pathological hips (15 reducible dislocations, 29 major instability).
- Treatment with the Pavlik harness commenced early, at an average of 3.4 days of life.
- The average duration of treatment was 27.9 days.
Main Results:
- Successful stabilization and spontaneous correction of acetabular dysplasia were observed in 39 hips (97.7% of cases).
- Four hips showed late correction of dysplasia.
- One case was considered a treatment failure.
- No major complications, including post-reduction osteochondritis, were reported.
Conclusions:
- Two distinct hip conditions are identified: neonatal symptomatic dislocation (likely in utero origin) and asymptomatic primary dysplasia.
- Immediate treatment is recommended for symptomatic hips, continuing until stability is confirmed (3-5 weeks).
- Exclusion criteria include simple dysplasia of dislocatable hips and irreducible dislocations due to their spontaneous course or higher complication risk, respectively.
Purpose Of The Study:
The purpose of this work was to study early short-term treatment of reducible dislocated or very unstable dislocated hips using the Pavlik harness. This approach is based on the theory of that dislocation favors dysplasia and that spontaneous correction occurs if the hip is reduced and stable. Very easily dislocated hips have been qualified as "major instability" if voluntary dislocation was easily achieved. In this case, it is very difficult to predict whether postnatal capsuloligamentary retraction will occur in the reduced or dislocated position.
Material And Methods:
We retained for study 34 patients with 44 pathological hips; 15 hips presented reducible dislocation and 29 major instability. Treatment began early at 3.4 days of life on average and lasted 27.9 days.
Results:
Outcome was very good for 39 hips with stabilization and spontaneous correction of the acetabular dysplasia, good in four with late correction of the dysplasia, and a failure in one. There were no major complications, none of the patients presented post-reduction osteochondritis.
Discussion:
Two different entities can be distinguished: dislocation producing dysplasia which is symptomatic neonatally and would imply pathogenic in utero events, and primary dysplasia which can be asymptomatic at birth and for which correction is not spontaneous. If the hip is symptomatic at birth, treatment should begin immediately and be continued to confirmation that the reduced hip is stable, i.e. about three to five weeks on average. Simple dysplasia of dislocatable hips should be excluded from this strategy because of their favorable spontaneous course. Likewise for irreducible dislocated hips because of the higher risk of complications. Under these conditions, this therapeutic strategy is effective for the reduction, stability, and correction of dysplasia achieved in 97.7% of cases without increasing the rate of complications.
